Penobscot County, Maine, is grappling with the biggest HIV outbreak within the state’s historical past. Dwelling to Bangor, a metropolis of roughly 32,000, the county has recognized 28 new circumstances over almost two years. That’s seven instances the standard quantity for that size of time. Almost all circumstances are amongst individuals who use medicine and are homeless.
Public well being consultants and native advocates say the outbreak is fueled by a confluence of on-the-ground elements: the sidelining and shutting of applications that distributed sterile syringes to individuals who use medicine, a scarcity of medical suppliers centered on HIV, and the clearing of the town’s largest homeless encampment, which upended look after newly identified individuals residing there.
However these points could not stay native for lengthy.
The Trump administration is pushing related ways nationwide. In a latest govt order, Trump known as for defunding applications that have interaction in hurt discount — a broad time period that encompasses many public well being interventions, together with syringe companies, aimed toward maintaining individuals who use medicine alive. Such efforts are typically controversial, with critics saying they permit criminality. The chief order additionally helps forcing homeless individuals off the road and into remedy. This comes after the administration reduce or delayed funding for numerous dependancy and HIV-related applications and hollowed out federal companies centered on these matters.
The administration says its strategy will improve public security, however a long time of analysis counsel in any other case. Many advocates and researchers warn these efforts may spark extra outbreaks just like the one in Bangor.
“That feels inevitable,” mentioned Laura Pegram, director of Drug Person Well being for NASTAD, an affiliation of public well being officers who administer HIV and hepatitis applications.
She mentioned individuals who use medicine face a trifecta of dangers: HIV, hepatitis C, and overdose. “Across the country, I think we’ll start to see those three things starting to be on the rise again.”
“That will be incredibly costly,” she added — in {dollars} and “in a real human way.”
Outbreaks that begin amongst individuals who use medicine can simply unfold to those that don’t.
An HIV Outbreak
The primary HIV case in Bangor’s present outbreak appeared in October 2023, nicely earlier than Trump’s return to the presidency.
Puthiery Va, director of Maine’s public well being division, attributed the emergence to the opioid epidemic, housing shortages, and the larger Bangor space’s sparse well being care companies.
Native advocates highlighted a further, acute issue: provide shortages on the area’s largest syringe companies program and its subsequent closure.
A nonprofit that supplied well being care and social companies to individuals who use medicine, Well being Fairness Alliance, or HEAL, distributed greater than half 1,000,000 sterile needles yearly.
Like different such applications nationwide, its aim was to stop the unfold of infectious illness that may happen if individuals share needles to inject medicine.
Nonetheless, monetary struggles and mismanagement led to extreme shortages lately. Former HEAL govt director Josh D’Alessio acknowledged such points, telling KFF Well being Information, “We did run out of syringes” at instances or restrict what number of members may take. A number of of those shortages struck within the fall of 2023, main HEAL staffers to counsel a hyperlink to the primary HIV case.
The Way forward for Hurt Discount
Analysis suggests a powerful connection between previous HIV outbreaks amongst individuals who use medicine and lack of entry to sterile needles, mentioned Thomas Stopka, an epidemiologist at Tufts College College of Medication.
A 2015 outbreak in Scott County, Indiana, and one within the Merrimack Valley of Massachusetts a number of years later had been curbed solely after syringe companies applications ramped up, he mentioned. If such applications had existed sooner in Scott County, greater than 100 infections may have been prevented, one examine recommended.
Va, who leads the Maine Heart for Illness Management and Prevention, mentioned she considers the scarcity of syringe companies within the Bangor space to be an element within the outbreak however not the first trigger.
Stopka mentioned the most effective follow throughout an outbreak “is to amplify access to sterile syringes.”
However Trump’s latest govt order hyperlinks harm-reduction applications to crime, saying such efforts “only facilitate illegal drug use and its attendant harm.” The order doesn’t identify syringe companies applications — which have been supported by each Democrats and Republicans prior to now — however it targets “safe consumption” websites, the place individuals can use medicine underneath supervision. Many advocates fear the assaults shall be broader.
A letter from the nation’s main dependancy company increasing on Trump’s govt order mentioned federal funds can’t be used to purchase syringes or drug pipes. Nonetheless, that has been true for many of the previous few a long time. The letter didn’t handle supporting basic working prices for syringe companies applications.
Division of Well being and Human Companies spokesperson Andrew Nixon advised KFF Well being Information that the administration is dedicated to “addressing the addiction and overdose crisis impacting communities across our nation.” However he and spokespeople for the White Home didn’t reply to particular questions in regards to the administration’s stance towards syringe companies.
In Bangor, some locals have raised issues about hurt discount that echo the president’s. At a March 2024 Metropolis Council assembly — shortly after a syringe companies program was newly licensed by the state to function domestically — residents and enterprise homeowners mentioned they felt unsafe with the rising inhabitants of people that had been homeless and utilizing medicine. They anxious syringe applications had been fueling the conduct.
However analysis suggests syringe companies applications cut back discarded needles in the neighborhood and don’t improve crime. They can halve new HIV and hepatitis C circumstances, improve entry into dependancy remedy fivefold, and save taxpayer cash. They’re additionally main distributors of overdose reversal drugs, the usage of which many communities — and the Trump administration — have mentioned they assist.
The town finally determined the newly licensed program, Needlepoint Sanctuary, couldn’t function in outstanding public parks or squares.
Within the following months, Needlepoint ran its syringe companies solely on the metropolis’s largest homeless encampment, the place a number of individuals had examined constructive for HIV, mentioned the group’s govt director, William “Willie” Hurley. That resulted in February when the town cleared the encampment.
This summer season, Needlepoint secured a personal location for its syringe companies however shut it down 5 days later when metropolis officers raised zoning issues.
Jennifer Gunderman, director of Bangor’s well being division, mentioned the town is attempting to strike a steadiness between “making services available and what the community wants.”
“Getting the buy-in of most of the community” is “critical to the future of harm reduction,” she mentioned.
Different cities in Maine and past have seen backlash lead to new legal guidelines that limit how syringe companies applications function or shutter them.
Gunderman mentioned she is hoping to keep away from that in Bangor.
Clearing Encampments
Trump’s latest govt order additionally requires clearing homeless individuals off the road and involuntarily committing them to remedy amenities.
The administration is enacting this coverage in Washington, D.C., the place it has bulldozed tents and threatened homeless individuals with fines and jail time in the event that they don’t go away the streets.
White Home spokesperson Abigail Jackson mentioned individuals have the choice to be taken to a shelter or obtain dependancy and psychological well being companies.
Comparable insurance policies have taken maintain nationwide lately, even in liberal hubs like New York and California.
Final 12 months in Bangor, as a homeless encampment that had existed for a number of years grew to just about 100 residents, enterprise homeowners and locals known as for its clearing.
Some advocates and social service suppliers warned that doing so may exacerbate the HIV outbreak and overdose disaster. At two Metropolis Council conferences in November, they defined that it might be tough to seek out individuals they served after a clearing and that scattering newly identified individuals may spark HIV clusters elsewhere.
“Plenty of people said you’re going to lose track of these people,” Amy Clark, a board member for the Bangor Space Restoration Community, advised KFF Well being Information. “They did it anyway.”
‘I’m Nonetheless Alive’
Two months after clearing the encampment, the town reported not figuring out the placement of greater than a 3rd of the individuals who had lived there.
Clark mentioned it’s not shocking that the town couldn’t join everybody to housing or remedy. Many individuals mistrust these companies, shelters are ceaselessly full, and remedy companies are scarce. “Where exactly are these people supposed to go?” she mentioned.
Metropolis officers careworn in Council conferences and experiences that they had been taking a humane strategy. They ramped up social companies for months main as much as the clearing, connecting individuals to all the things from housing to storage amenities and laundry.
Gunderman, the town well being director, mentioned she is aware of the sweep wasn’t perfect however that neither was crowding people in an unsanitary encampment. “It was a situation where there weren’t a lot of great answers,” she mentioned.
To assist observe people from the encampment and preserve them engaged in HIV remedy, the town is now utilizing about $550,000 in opioid settlement funds to rent two case managers. (The one different native HIV medical case administration program shuttered over the summer season.)
“What we know from outreach we’ve been doing already is that we spend a lot of time looking for people,” Gunderman mentioned.
Jason, who has been homeless for many of the previous decade and examined constructive for HIV this 12 months, has seen that in motion.
Members of what he calls his medical group have scoured the streets for hours to seek out his tent and remind him to take his HIV remedy photographs, he mentioned. Some picked up prescriptions and delivered them to him.
“They’ve made sure I’m taken care of,” Jason mentioned. (KFF Well being Information agreed to make use of solely his first identify to guard his privateness.)
Jason believes he received the virus final 12 months on the homeless encampment whereas utilizing medicine that another person ready. He had tried to keep away from the encampment for months. However each time he arrange his tent elsewhere, he mentioned, cops advised him to maneuver.
When he received the analysis, he considered his uncle, who died of AIDS within the Nineteen Eighties.
“It hurts to talk about,” Jason mentioned, “but I’m still alive.”
After months of remedy, his viral load is now undetectable. Over the summer season, his group helped him discover housing.
However Jason remains to be struggling to seek out sterile needles repeatedly. He worries about others dealing with a scarcity.
“That’s how this outbreak has been spreading more and more,” Jason mentioned. “Every time we turn around there’s another case.”
